Acupuncture for functional recovery after stroke: a systematic review of sham-controlled randomized clinical trials

Abstract

Background: Acupuncture is frequently advocated as an adjunct treatment during stroke rehabilitation. The aim of this review was to assess its effectiveness in this setting. Methods:We searched 25 databases and 12 major Korean traditional medicine journals from their inception to October 2009. We included randomized controlled trials, with no language restrictions, that compared the effects of acupuncture (with or without electrical stimulation) with sham acupuncture. We assessed the methodologic quality of the trials using the Cochrane risk-of-bias criteria and the PEDro (Physiotherapy Evidence Database) scale.Results: Ten of 664 potentially relevant studies met our inclusion criteria. For acute and subacute stages after stroke, we included seven trials. A meta-analysis of the five studies that assessed functionality did not show a significant difference in favour of acupuncture, with high heterogeneity. A post-hoc sensitivity analysis of three trials with low risk of bias did not show beneficial effects of acupuncture on activities of daily living at the end of the intervention period (n = 244; standard mean difference 0.07, 95% confidence interval [CI] -0.18 to 0.32; I 2 = 0%) or after follow-up (n = 244; standard mean difference 0.10, 95% CI -0.15 to 0.35; I 2 = 0%). For the chronic stage after stroke, three trials tested effects of acupuncture on function according to the Modified Ashworth Scale; all failed to show favourable effects. Interpretation:Our meta-analyses of data from rigorous randomized sham-controlled trials did not show a positive effect of acupuncture as a treatment for functional recovery after stroke. Research Appendix 2, available at www.cmaj.ca /cgi /content /full /cmaj .091113 /DC1). We also searched our own files manually for relevant articles. Hard copies of all articles were obtained and read in full. No language restrictions were imposed. We included dissertations and abstracts, provided they contained sufficient detail for critical evaluation. Abstract

Acupuncture for Shoulder Pain After Stroke: A Systematic Review

“…Several other systematic reviews assessing the effects of acupuncture for stroke have been published. 20,21 Most of them focused on the recovery of general status after stroke in rehabilitation, as measured by the Barthel Index, Nottingham Health Profile, or Scandinavian Stroke Scale. There were several limitations in the evidence showing an effect of acupuncture for stroke.…”

Methological quality of systematic reviews and meta-analyses on acupuncture for stroke: A review of review

“…The criteria drafted by the authors were used in 10 reviews, (10,24,26,27,29,31,41,(46)(47)(48) which usually contained randomization, concealment, blinded, dropout, and ITT analysis. Fourteen reviews used Cochrane risk of bias tool, (11,20,22,23,25,28,30,33,36,37,(42)(43)(44)(45) and 2 reviews also used PEDro. (28,43) Jadad scale was used in 8 reviews.…”

The Effects of Acupuncture on Cerebral Blood Flow in Post-Stroke Patients: A Randomized Controlled Trial

“…Some systematic reviews and meta-analyses found acupuncture to be effective, 7,9 while others did not. 6,8 It is hoped that this study will contribute to the favoring of acupuncture treatment in future meta-analyses for this population.…”

“…5 Acupuncture is often used as an adjunct to standardized rehabilitation treatments after stroke, but its mode of action in the rehabilitation of these patients is yet to be discovered. [6][7][8][9] Acupuncture influences cerebral blood flow in healthy persons [10][11][12] and patients with stroke. 13,14 However, few studies on cerebral blood flow in patients after stroke have used sham acupuncture.…”